Association of Incident Cardiovascular Disease With Progression of Sleep-Disordered Breathing

Abstract

Background—Prospective data suggest that sleep-disordered breathing enhances risk for incident and recurrent cardiovascular disease (CVD). However, a reverse causal pathway whereby incident CVD causes or worsens sleep-disordered breathing has not been studied. Methods and Results—2721 Sleep Heart Health Study participants (mean age 62 (SD10) years, 57% women, 23% minority) without CVD at baseline underwent two polysomnograms 5 years apart. Incident CVD events, including myocardial infarction, congestive heart failure and stroke, were ascertained and adjudicated. The relation of incident CVD to change in apnea- hypopnea index (AHI) between the two polysomnograms was tested using general linear models, adjusting for age, sex, race, study center, history of diabetes, change in BMI, change in neck circumference, percent sleep time spent in supine sleep and the time between the two polysomnograms. Incident CVD occurred in 95 participants between the first and second polysomnograms. Compared to participants without incident CVD, those with incident CVD experienced larger increases in AHI between polysomnograms. The difference in adjusted mean AHI change between subjects with and without incident CVD was 2.75 events per hour (95%CI 0.26, 5.24; p=0.032). This association persisted after excluding subjects with central sleep apnea. Compared to participants without incident CVD, participants with incident CVD had greater increases in both mean obstructive and central apnea indices, by 1.75 events per hour (95%CI 0.10, 1.75; p=0.04) and by 1.07 events per hour (95%CI 0.40, 1.74; p=0.001) respectively. Conclusions—In a diverse, community-based sample of middle-aged and older adults, incident CVD was associated with worsening sleep-disordered breathing over 5 years.